Filler Injection For "Visible Shield Graft Edges - Tombstone Deformity"

Non Surgical Nose Job With Filler For Camouflaging The Shield Graft

Tombstone Deformity is the situation in which the appearance of a tombstone at the tip of the nose appears after the healing of the placed shield grafts over time in patients with ice skin structure. Generally, there is pitting and sharp cartilage edge image on both sides of the graft over time. I don't like using shield graft, especially in patients with thin skin features. I generally prefer to use cap grafts. In the treatment of Tombstone Deformity, removal of this graft, placing marginal rim grafts on both sides, or camouflaging the sharp edges by covering it with a tissue such as soft tissue, cartilage membrane, fascia can be considered. The link where you can find more detailed information on the subject >> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3199824/

Because the patient did not accept the operation, a non-surgical nose job procedure was performed with fillers containing hyaluronic acid, which only gives a limited amount of camouflage effect. It is aimed to obtain a softer area by injecting fillers around the shield graft.

In this case, revision rhinoplasty operation can be planned. It can be planned to remove the shield graft or to place marginal rim grafts on both sides, and to camouflage the graft with soft tissue. In this website, you can find the noses of similar patients before and after the operation by searching for the words revision nose tip plasty.

One of the disadvantages of thin-skinned noses is the low camouflage effect after rhinoplasty

After rhinoplasty operations with thin skin features, although the overall recovery rate and edema time are low; In addition to this, an important disadvantage is that the asymmetrical areas under the skin or the sharp-edged areas can easily be defined outside the skin. In patients with very thin skin, sometimes even primary rhinoplasty; It may be possible to use a graft that provides a natural camouflage effect, such as the temporal muscle fascia. In patients with thin skin features and symmetrical nose features, when symmetric surgical trauma is performed, there may be a very short recovery time and these are the nose shapes desired by many rhinoplasty surgeries. However, in thin-skinned rhinoplasty operations, placing thick ans sharp cartilage graft just under the skin can cause problems such as the tombstone deformity that I have shared here.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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